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EW SHOW DAILY 18 Wednesday, April 18, 2018 Visit Quidel at Booth 809 quidel.com MMP-9 TEST Adenoviral conjunctivitis TEST Introducing Quidel's Innovative Eye Health Solutions Quidel_ACRS_2018_FCBannerAds.qxp_Layout 1 3/29/18 8:21 AM Page 4 by Chiles Aedam R. Samaniego EyeWorld Asia-Pacific Senior Staff Writer New generation of cataract surgeons growing up with laser cataract surgery patterns the femtosecond laser can create, how to change the pattern based on the hardness and consis- tency of the cataract. Dr. Walton further recommend- ed that surgeons cherry pick their first cases, considering where laser cataract surgery is known to excel. In his case, he said, he loves toric lenses and would implant a toric in a laser cataract surgery procedure, taking advantage of the precise, pre- dictable, and complete 360-degree capsular overlap the femtosecond laser provides. The procedure also excels in complicated cases. Dr. Williamson suggested using laser cataract surgery in cases with zonulopathy and dense lenses from traumatic cataract, and for astigmatic keratotomy, which allows the possibility of titrating the refraction. Dr. Walton contemplated the different mindsets that might help or hinder the progress of laser cataract surgery. While whether someone wants to do laser cataract surgery or not absolutely does not determine whether they are a good cataract surgeon, moving forward requires a mindset open to finding something that will improve results rather than just falling back on the familiar. Dr. Williamson said that these practices should also continue to focus on what the femtosecond does do—providing predictability and automating the procedure. The data regarding the procedure's safety, he said, is there, but will accumulate even more over the time. In any case, he said, he thinks femto is here to stay. EW Editors' note: Dr. Williamson has financial interests with Alcon (Fort Worth, Texas), Bausch + Lomb (Bridgewater, New Jersey), and Johnson & Johnson Vision (Santa Ana, Cali- fornia). Dr. Walton has no financial interests related to his presentation. A ttendees of the 2018 ASCRS•ASOA Annual Meeting were offered a glimpse of a side of the laser cataract surgery narrative not often seen amid the numerous conversations surround- ing the still evolving procedure. In an unusually formatted, double-speaker, conversational presentation, Bennett Walton, MD, MBA, Houston, and Blake William- son, MD, Baton Rouge, Louisiana, riffed on each others' thoughts on their experiences with laser cata- ract surgery in the context of their respective residencies, training, and practices. Dr. Walton noted how he and Dr. Williamson were of the genera- tion for whom laser cataract surgery is a wholly present, contemporary technology. Already out commer- cially during their residency, laser cataract surgery was even included in some programs available at the time; Dr. Walton himself had some experience with laser cataract sur- gery during his residency. Dr. Williamson, however, did not. There was, he thinks, "a lot of confusion," and many of his men- Dr. Walton shares his experiences with femtosecond laser cataract surgery during residency training. tors did not understand the benefits of the technology. Today, though, Dr. Walton said that in a survey he conducted, more than half of residents are graduating from their residencies with experi- ence doing femtosecond laser-as- sisted cataract surgery. He posited that these programs tend to have what he calls a "refractive mind- set"—programs with femtosecond laser training generally also teach their residents to perform manual limbal or peripheral corneal relaxing incisions. Dr. Walton's poll, Dr. William- son said, illustrates the value of in- stilling this refractive mindset early in residents' minds. Dr. Walton said that while a majority of residents surveyed described their faculty as not seeing the benefit of using the femtosecond laser, more than half of the residents wanted to eventually join a practice that had one. Dr. Williamson reiterated how lucky Dr. Walton was to have had the femtosecond laser during his res- idency training. While Dr. William- son had the benefit of being part of a 70-year-old family practice, he had to admit that the femtosecond laser was the one thing they were missing. At his family's practice, he had to push his father to get the tech- nology. Dr. Williamson said that his father had fixated on the idea that having the femtosecond laser was simply something he didn't need, that he had already refined and per- fected his technique. Dr. Williamson said he thought his father was missing the point. Rather, he recognized that making something more automated is a good thing, and that is what laser cataract surgery does, essentially. "It's the next level to automation," he said. Moreover, he said laser cataract surgery is a practice builder, allowing practices to add astigmatic correc- tion to their services. Eventually, he was able to con- vince his father, who he described as "an anti-femto guy," by arguing along these lines. Nevertheless, Dr. Walton and Dr. Williamson still exist at a mid- dling point in the evolution of laser cataract surgery, such that to begin performing laser cataract surgery still largely means transitioning from manual phacoemulsification surgery. They offered a few tips for this transition. Dr. Walton said that what sur- geons do with manual phaco is not necessarily something they should also do when performing laser cata- ract surgery. For instance, while he very much likes using the Nagahara chopper for manual phaco, it is not a good instrument for laser cataract surgery. Meanwhile, Dr. Williamson said that surgeons need to change their thinking regarding hydrodissection when transitioning to laser cataract surgery because pneumodissection will already have occurred with the femtosecond laser. Moreover, they need to understand the various grid

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